Asplenia

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Absence of a functioning spleen. Hyposplenism is one step away from asplenia. Can give rise to Howell-Jolly bodies on a blood film.

The spleen is part of the reticulo-endothelial system and has an important role in filtering the blood, firstly to remove blood cells and also for immune surveillance. The absence of a spleen predisposes the individual to infection from capsulated organisms such as Meningococcus, Pneumococcus and Haemophilus influenzae.

Prevention of infection

LogoKeyPointsBox.pngRecommendations vary from nothing to 2 years, 5 years and lifelong.

Vaccination against capsulated organisms recommended, but no agreed consensus regarding antibiotic prophylaxis.[1] Arguments against include the rising incidence of penicillin-resistant organisms and the difficulty of maininting life-long compliance. Some recommendations suggest an initial 2 year period of prophylaxis. Those who recommend no antibiotics recommend that patients be given a supply of antibiotics in the event of illness, accompanied with advice for the patient to have a low threshold for seeking medical attention in the event of signs of infection. An alert card/bracelet may also be helpful.

The age at which the spleeen is removed may have a bearing on the risk of overwhelming sepsis. Children (under 16) seem particularly susceptible. For adults, the wide range of pathologies that lead eventually to splenectomy means that good quality evidence is lacking. The indication for splenectomy may also have a bearing. Traumatic splenectomies may sometimes have some residual splenic tissue and therefore at lower risk. Conversely, those who have splenectomy as part of treatment for haematological malignancies may be immunosuppressed.

The British Committee for Standards in Haematology has published the guideline which states:[2]

For those travelling, malaria prophylaxis is also important.

All splenectomised patients and those with functional hyposplenism should receive pneumococcal immunisation and patients not previously immunised should receive Haemophilus influenza type b vaccine. Patients not previously immunised should receive Meningococcal Group C conjugate vaccine. Influenza immunisation should be given. Life long prophylactic antibiotics are still recommended (oral Phenoxymethylpenicillin or Erythromycin).

Guidelines on vaccination are given in Chapter 7 of the "Green Book".[3]

External links

References